Certain changes in the vessels and vascular coats of the eye which are of diagnostic and prognostic value in general disease / by G. E. de Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Certain changes in the vessels and vascular coats of the eye which are of diagnostic and prognostic value in general disease / by G. E. de Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    11/14 (page 11)
    lated according to the findings. But for the attack of conjunc- tivitis which led to the examination of the fundus this condition would not have been discovered. A very important and interesting relationship in this patient existed between the* attacks of scleral and conjunctival conges- tions and the retinal changes. They almost certainly preceded the lesions in the fundus, and even now—for the patient is still under observation—it would seem that episcleral attacks and reti- nal extravasations may alternate. In this respect they somewhat resemble the behavior of the recurring subconjunctival hemor- rhages already described. A case to illustrate prognosis: A clergyman, aged forty-six, a native of America, consulted me because he believed he needed change in glasses, which he had worn for a number of years for as- tigmatism. Ophthalmoscopic examination at that time did not reveal any marked retinal change, except very full tortuous veins, exhibiting characteristically the impeded circulation already de- scribed, and some grayness of the optic discs. New glasses were furnished, and three weeks later he reappeared, stating that there appeared to be a faint blur before one eye, which he believed to be due to the fact that the glass was not entirely suitable. Ophthal- moscopic examination now revealed increased tortuosity in the veins, with increased signs of mechanical pressure, and a soft, yel- lowish-white extravasation in the retina up and out from the disc, near the edge of which were a few striated hemorrhages. The rest of the eyeground was free from disease, nor were there hemor- rhages or extravasations in the retina of the left side. The patient had suffered from dyspepsia for a long time, had occasionally had palpitation of the heart and drowsiness. Examination of the urine revealed a low specific gravity and an inconstant slight albumi- nuria. The arteries were hard and showed high tension. There was a faint mitral regurgitant blowing sound, which Dr. Hare, who examined him from the general standpoint, described as a blurring of the sound rather than a real murmur. The treatment consisted in proper regulation of diet and duties. The patient was told of his precarious condition and his people warned that sudden death might be expected—a warning which was realized two months later, when in the middle of the night he developed signs of intra- cranial hemorrhage and died in a few hours. Autopsy was not permitted. The serious prognostic import of retinal hemorrhage is well known, but sometimes it appears to be neglected. Hasket Derby {Transactions of the Massachusetts Medical Society, June 2, 1897), writing on the occurrence of retinal hemorrhage after middle age and its bearing on the duration of life, analyzed thirty-one cases, the patients being between the ages of forty-three and eighty- three. Twenty-fi ve of these died after brief illnesses, some with great suddenness. Eleven of this number died of heart disease, fourteen of apoplexy. Mr. Marcus Gnnn (Loc. cit., page 365) has also re- corded a series of cases which illustrate the intimate association